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General NPI Number Information
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NPI Number | 1922356369
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Entity Type | Organization
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Legal Business Name | TRI-STATE COMMUNITY HEALTHCARE CENTER
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 06/08/2023
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Provider Practice Location Address
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Address Line | 1402 BAILEY AVE
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City | NEEDLES
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State | CA
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Zip | 92363-3104
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Country | US
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Telephone | 760-326-0222
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Fax | 769-326-0221
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Provider Business Mailing Address
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Address Line | 820 W BROADWAY ST
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City | NEEDLES
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State | CA
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Zip | 92363-2729
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Country | US
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Telephone | 760-326-0222
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Fax | 760-326-0221
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Authorized Official
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Title or Position | CEO
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Name | ARAM MANOUKIAN
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Credential |
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Telephone | 818-652-6612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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